BOOK ORDER FORM:

“The Awakening of a Surgeon”

 By Dr. David Janda

Order

Total Quantity      _____ x  $ 17.00   =                                    ________
USA Ship. & Hand.($4 First Book / $ 3 Each Additional book)          ________
Foreign Orders ( Add $5 per book for Shipping)                                       __________

TOTAL:      ________

____ Please have Dr. Janda sign my book- To:______________________________

Payment Method: 

___     Check or Money Order made payable to: I.P.S.M

___     Please Bill my: (circle one)    VISA    or       Mastercard

           Credit Card #__________________________  Exp Date __________ 
           Signature      __________________________

Shipping Information

Name _________________________________________________

Address _______________________________________________

City/State/Zip  ___________________________________________

Phone___________________ email __________________________

FAX THIS ORDER FORM TO:  (734) 424-1706   or   (734) 572-4503 Attn: Beth
OR
MAIL TO:      I.P.S.M.  /   P.O. box 7032  / Ann Arbor  / MI  / 48103  / USA